- Email: [email protected]
Prostate Cancer Screening
BOOK REVIEWS
Increased Bladder Apoptosis With ␣-1 Adrenoceptor Antagonists in Benign Prostatic Hyperplasia ˇ , K. H. GULKESEN ˇ , E. KUKUL, M. YALC¸ INKAYA, G. KARPUZOGLU AND M. BAYKARA, Departments of T. ERDOGRU Urology and Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey Scand J Urol Nephrol, 36: 188 –193, 2002 Objective: To determine whether preoperative usage of ␣-1 adrenoceptor antagonists (␣-1ARA) prevents the alterations in bladder wall components due to obstruction via changing apoptotic and/or proliferative activity and provides an advantage for improvement of irritative symptoms following removement of bladder outlet obstruction. Material and Methods: A total of 39 patients were enrolled to the present study. According to preoperative medical treatment, patients were divided into 2 groups as preoperative untreated (n ⫽ 15) and medically treated patients with ␣-1ARA (n ⫽ 24). Apoptotic and proliferative indices of bladder wall were determined with TUNEL assay and proliferating cell nuclear antigen immunoreactivity, respectively. Results: While the mean apoptotic indexes (AI) of lamina propria were 0.293 ⫾ 0.163 vs 0.978 ⫾ 0.194 in untreated and treated patients, the mean AI of myofibroblast cells were 0.10 ⫾ 0.06 and 0.90 ⫾ 0.23 in untreated and treated patients, respectively. There were statistically significant differences between lamina propria (p ⫽ 0.0067) and myofibroblast cells (p ⫽ 0.0280) AI in the two groups. However, there were no significant differences between postoperative symptom indices in preoperatively treated and untreated groups. Conclusions: ␣1-ARA treatment might have an effect on hypertrophy and supersensitivity of bladder wall due to increased outlet obstruction via prevention of the imbalance between cell proliferation and apoptosis, providing normal homeostatic control mechanisms, through the interval between the onset of the lower urinary tract symptoms and time surgical intervention. However, further studies should be organized to demonstrate the impact of long-term ␣1-ARA medication for post-operative significant improvement on irritative symptom index. Editorial Comment: Often basic science findings do not correlate with what we see in daily practice. This disparity may be due to selection of the wrong investigational model. The effects of ␣-blockers on apoptosis within the prostate have been well documented. In this study men who were treated with an ␣-blocker before transurethral prostatectomy were compared to those who underwent the procedure without prior ␣-blocker therapy. This study demonstrates that there are differences between treated and untreated men in the apoptotic indexes of myofibroblast cells and the lamina propria of the bladder. Is this finding clinically relevant? Paradoxically there were no differences in symptom improvement between the groups. Is this because bladder analysis should have been performed before therapy was administered? Or are changes in apoptosis clinically irrelevant? It has been postulated that in the Medical Therapy of Prostatic Symptoms study the delay in the incidence of urinary retention in the ␣-blocker arm was secondary to apoptosis. The continued effect, seen only in men who were treated with finasteride, may have been secondary to decrease in prostate volume. Steven A. Kaplan, M.D.
BOOK REVIEWS Prostate Cancer Screening I. M. THOMPSON, M. I. RESNICK
AND
E. A. KLEIN, Totowa, New Jersey: Humana Press, 317 pages, 2001
This book offers a well-balanced review of critical issues regarding prostate cancer screening. A variety of topics ranging from the epidemiology and natural history of prostate cancer to progress reports on American, European and Canadian prospective randomized screening trials are covered. There are chapters reviewing the current role and potential uses of prostate specific antigen (PSA) derivatives, neural networks and new prostate cancer imaging techniques, as well as a chapter outlining recommendations regarding prostate cancer screening by the relevant national medical organizations. Cogent arguments supporting the usefulness of prostate cancer screening and cautioning against blind acceptance of universal screening are presented in 2 separate chapters. The book also covers some less commonly discussed topics, such as informed consent, quality of life and behavior of men undergoing prostate cancer screening. An interesting chapter that presents state-of-the-art methods for screening of other common adult cancers places issues surrounding prostate cancer screening in a broader prospective. One unique aspect of this book is Paul Lange’s personal reflection on his experience with PSA screening and prostate cancer as a urologist and a patient. Another unique aspect of the book is the inclusion of a
1623
1624
BOOK REVIEWS
compact disc containing a prototype version of Cancer of the Prostate Risk Index. This software predicts prostate cancer risk based on total PSA, digital rectal examination, race and age. In general, the individual chapters are concisely written and highly informative. The main shortcoming of the book is the organization of the chapters, which do not appear to follow any logical order. The book includes a progress report on the European Randomized Study of Screening for Prostate Cancer but does not mention the National Cancer Institute sponsored Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. In addition, there is an entire chapter devoted to the Laval University Screening Trial. Although this trial demonstrated a benefit for screening, some have questioned the validity of its findings due to multiple flaws in the study design. A discussion about the limitation of this study should have been included in this book. The only other significant omission is the lack of discussion about optimizing screening strategies. Major controversies surrounding the most appropriate PSA cutoff, age to begin screening and frequency of screening still exist, and discussions of these topics would have enhanced this book. Prostate cancer screening remains a widely discussed and hotly debated topic. Although multiple studies and review articles have been published on the subject, this book is a worthwhile read for clinicians, researchers and patients interested in prostate cancer screening. The editors should be commended for producing this valuable piece of work. David K. Ornstein, M.D. Division of Urology Department of Surgery University of North Carolina Chapel Hill, North Carolina Urologic Prostheses: The Complete Guide to Devices, Their Implantation, and Patient Follow-Up C. C. CARSON, III, Totowa, New Jersey: Humana Press, 300 pages, 2002 One in a continuing series of texts that focus on current clinical urology, this edition is presented as the complete practical guide to urological prosthetics. The multiauthored treatise reviews the historical development of prosthetics through present day tissue engineering strategies and the future of clinical gene therapy. The book contains 18 chapters, including 8 on penile prostheses, with emphasis on selection criteria, and experience with various models, complications and results. Three chapters are dedicated to the subject of urethral bulking agents. Two chapters on artificial urinary sphincters are also presented, as well as 2 chapters on urethral stents and their indications and outcomes. In addition, a chapter is devoted to the issues and controversy surrounding placement of testicular prostheses in the modern era. Many of the chapters are excellent and concise, making good use of tables, figures and illustrations. However, the book itself is not concise. While the individual expertise of each author is apparent, the editor has allowed a significant amount of overlay and redundancy. As a result, a chapter on penile prosthetics included several pages on Peyronie’s disease and artificial urinary sphincters, which are covered elsewhere in the text. Urethral bulking agents, discussed in 3 chapters, could have been consolidated into 1 chapter, and urethral stents and artificial urinary sphincters could have been handled similarly. However, the most notable shortcoming is the absence of a timely review on prosthetic material currently used in male and female slings. This area is experiencing renewed interest, and we as urologists currently deal with many questions from other health professionals and patients about the benefits and risks of prosthetic slings such as tension-free vaginal tape. Despite falling short of being the “complete” guide to prosthetics in urology as implied by its title, this text goes a long way toward providing a substantial resource for the resident in training and the young emerging urologist with limited exposure to prosthetics during residency. Finally, a busy clinician in practice looking for an up-to-date reference to handle a variety of prosthetic implantation issues would not be disappointed in this book. John J. Smith, III, M.D. Department of Urology Lahey Clinic Medical Center Burlington, Massachusetts
Increased Bladder Apoptosis With ␣-1 Adrenoceptor Antagonists in Benign Prostatic Hyperplasia ˇ , K. H. GULKESEN ˇ , E. KUKUL, M. YALC¸ INKAYA, G. KARPUZOGLU AND M. BAYKARA, Departments of T. ERDOGRU Urology and Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey Scand J Urol Nephrol, 36: 188 –193, 2002 Objective: To determine whether preoperative usage of ␣-1 adrenoceptor antagonists (␣-1ARA) prevents the alterations in bladder wall components due to obstruction via changing apoptotic and/or proliferative activity and provides an advantage for improvement of irritative symptoms following removement of bladder outlet obstruction. Material and Methods: A total of 39 patients were enrolled to the present study. According to preoperative medical treatment, patients were divided into 2 groups as preoperative untreated (n ⫽ 15) and medically treated patients with ␣-1ARA (n ⫽ 24). Apoptotic and proliferative indices of bladder wall were determined with TUNEL assay and proliferating cell nuclear antigen immunoreactivity, respectively. Results: While the mean apoptotic indexes (AI) of lamina propria were 0.293 ⫾ 0.163 vs 0.978 ⫾ 0.194 in untreated and treated patients, the mean AI of myofibroblast cells were 0.10 ⫾ 0.06 and 0.90 ⫾ 0.23 in untreated and treated patients, respectively. There were statistically significant differences between lamina propria (p ⫽ 0.0067) and myofibroblast cells (p ⫽ 0.0280) AI in the two groups. However, there were no significant differences between postoperative symptom indices in preoperatively treated and untreated groups. Conclusions: ␣1-ARA treatment might have an effect on hypertrophy and supersensitivity of bladder wall due to increased outlet obstruction via prevention of the imbalance between cell proliferation and apoptosis, providing normal homeostatic control mechanisms, through the interval between the onset of the lower urinary tract symptoms and time surgical intervention. However, further studies should be organized to demonstrate the impact of long-term ␣1-ARA medication for post-operative significant improvement on irritative symptom index. Editorial Comment: Often basic science findings do not correlate with what we see in daily practice. This disparity may be due to selection of the wrong investigational model. The effects of ␣-blockers on apoptosis within the prostate have been well documented. In this study men who were treated with an ␣-blocker before transurethral prostatectomy were compared to those who underwent the procedure without prior ␣-blocker therapy. This study demonstrates that there are differences between treated and untreated men in the apoptotic indexes of myofibroblast cells and the lamina propria of the bladder. Is this finding clinically relevant? Paradoxically there were no differences in symptom improvement between the groups. Is this because bladder analysis should have been performed before therapy was administered? Or are changes in apoptosis clinically irrelevant? It has been postulated that in the Medical Therapy of Prostatic Symptoms study the delay in the incidence of urinary retention in the ␣-blocker arm was secondary to apoptosis. The continued effect, seen only in men who were treated with finasteride, may have been secondary to decrease in prostate volume. Steven A. Kaplan, M.D.
BOOK REVIEWS Prostate Cancer Screening I. M. THOMPSON, M. I. RESNICK
AND
E. A. KLEIN, Totowa, New Jersey: Humana Press, 317 pages, 2001
This book offers a well-balanced review of critical issues regarding prostate cancer screening. A variety of topics ranging from the epidemiology and natural history of prostate cancer to progress reports on American, European and Canadian prospective randomized screening trials are covered. There are chapters reviewing the current role and potential uses of prostate specific antigen (PSA) derivatives, neural networks and new prostate cancer imaging techniques, as well as a chapter outlining recommendations regarding prostate cancer screening by the relevant national medical organizations. Cogent arguments supporting the usefulness of prostate cancer screening and cautioning against blind acceptance of universal screening are presented in 2 separate chapters. The book also covers some less commonly discussed topics, such as informed consent, quality of life and behavior of men undergoing prostate cancer screening. An interesting chapter that presents state-of-the-art methods for screening of other common adult cancers places issues surrounding prostate cancer screening in a broader prospective. One unique aspect of this book is Paul Lange’s personal reflection on his experience with PSA screening and prostate cancer as a urologist and a patient. Another unique aspect of the book is the inclusion of a
1623
1624
BOOK REVIEWS
compact disc containing a prototype version of Cancer of the Prostate Risk Index. This software predicts prostate cancer risk based on total PSA, digital rectal examination, race and age. In general, the individual chapters are concisely written and highly informative. The main shortcoming of the book is the organization of the chapters, which do not appear to follow any logical order. The book includes a progress report on the European Randomized Study of Screening for Prostate Cancer but does not mention the National Cancer Institute sponsored Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. In addition, there is an entire chapter devoted to the Laval University Screening Trial. Although this trial demonstrated a benefit for screening, some have questioned the validity of its findings due to multiple flaws in the study design. A discussion about the limitation of this study should have been included in this book. The only other significant omission is the lack of discussion about optimizing screening strategies. Major controversies surrounding the most appropriate PSA cutoff, age to begin screening and frequency of screening still exist, and discussions of these topics would have enhanced this book. Prostate cancer screening remains a widely discussed and hotly debated topic. Although multiple studies and review articles have been published on the subject, this book is a worthwhile read for clinicians, researchers and patients interested in prostate cancer screening. The editors should be commended for producing this valuable piece of work. David K. Ornstein, M.D. Division of Urology Department of Surgery University of North Carolina Chapel Hill, North Carolina Urologic Prostheses: The Complete Guide to Devices, Their Implantation, and Patient Follow-Up C. C. CARSON, III, Totowa, New Jersey: Humana Press, 300 pages, 2002 One in a continuing series of texts that focus on current clinical urology, this edition is presented as the complete practical guide to urological prosthetics. The multiauthored treatise reviews the historical development of prosthetics through present day tissue engineering strategies and the future of clinical gene therapy. The book contains 18 chapters, including 8 on penile prostheses, with emphasis on selection criteria, and experience with various models, complications and results. Three chapters are dedicated to the subject of urethral bulking agents. Two chapters on artificial urinary sphincters are also presented, as well as 2 chapters on urethral stents and their indications and outcomes. In addition, a chapter is devoted to the issues and controversy surrounding placement of testicular prostheses in the modern era. Many of the chapters are excellent and concise, making good use of tables, figures and illustrations. However, the book itself is not concise. While the individual expertise of each author is apparent, the editor has allowed a significant amount of overlay and redundancy. As a result, a chapter on penile prosthetics included several pages on Peyronie’s disease and artificial urinary sphincters, which are covered elsewhere in the text. Urethral bulking agents, discussed in 3 chapters, could have been consolidated into 1 chapter, and urethral stents and artificial urinary sphincters could have been handled similarly. However, the most notable shortcoming is the absence of a timely review on prosthetic material currently used in male and female slings. This area is experiencing renewed interest, and we as urologists currently deal with many questions from other health professionals and patients about the benefits and risks of prosthetic slings such as tension-free vaginal tape. Despite falling short of being the “complete” guide to prosthetics in urology as implied by its title, this text goes a long way toward providing a substantial resource for the resident in training and the young emerging urologist with limited exposure to prosthetics during residency. Finally, a busy clinician in practice looking for an up-to-date reference to handle a variety of prosthetic implantation issues would not be disappointed in this book. John J. Smith, III, M.D. Department of Urology Lahey Clinic Medical Center Burlington, Massachusetts